建立稳定可持续的城乡居民医保筹资机制——以南昌市为例

Establish a Stable and Sustainable Financing Mechanism for Urban and Rural Residents’ Medical Insurance—Take Nanchang City as an Example

摘要: 建立科学稳定的筹资机制是实现居民医保制度可持续发展的必经之路。南昌市于2016年整合建立了城乡居民医保制度，对城镇、农村居民进行统一筹资。该制度的建立有效地增进了社会公平，使医疗保险制度的发展迈上新的台阶，但是，不合理的筹资结构、不适应经济发展水平的筹资水平、参保人群的逆向选择以及缺乏相关法律制度的约束等都在一定程度上限制了南昌市居民医保的可持续发展，背离了社会和谐稳定发展的初衷。本文提出以下几点对策以优化医保筹资机制：明确主体责任、合理分摊筹资比例；将筹资标准与居民、财政收入增长率挂钩；采取“以支定收”的筹资动态调整机制；完善相关法律法规，保障实现稳定筹资机制。

Abstract: The establishment of a scientific and stable financing mechanism is the only way to realize the sustainable development of the residents’ medical insurance system. In 2016, Nanchang inte-grated and established a medical insurance system for urban and rural residents, and unified fi-nancing for urban and rural residents. The establishment of the system has effectively improved social equity and brought the development of the medical insurance system to a new level. How-ever, the unreasonable financing structure, the financing level that is not suitable for the level of economic development, the adverse selection of the insured population and the lack of relevant laws. The constraints of the system have restricted the sustainable development of the residents’ medical insurance in Nanchang to a certain extent, deviating from the original intention of harmonious and stable development of society. This article proposes the following countermeasures to optimize the medical insurance financing mechanism: clarify the main responsibility, rationally apportion the financing ratio; link the financing standard to the growth rate of residents and fiscal revenue; adopt the “revenue by expenditure” financing dynamic adjustment mechanism; improve relevant laws and regulations, to ensure the realization of a stable financing mechanism.